Under the rumble of cars driving on the expressway, Philip Sylverin swept a portion of the sidewalk where he sleeps at night. He paused and leaned on a shopping cart packed with clothing and other personal items, a few feet from a milk crate tied to the chain-link fence that serves as a bookshelf.

He stood between barricades police recently placed at multiple intersections in this stretch of Overtown, preventing cars from driving on four roads running under the Dolphin/836 expressway that are lined with homeless people. On one street, police set up surveillance cameras Monday in hopes of capturing drug deals.

“We’re just trying to survive,” Sylverin said, a hypodermic needle in his hand.

Four streets between Northwest Second Avenue and Northwest First Avenue are now the center of a public health investigation into the transmission of hepatitis C and HIV, an issue stirring up reactions from politicians, police, the courts and homeless advocates. A Miami official said the number of cases in this area has recently increased.

Health officials are not commenting on the magnitude of the problem, citing an active investigation. But the situation is serious enough that Miami commissioners last week ordered the closure of these streets to traffic. Police have set up cameras. And representatives from multiple local and state agencies convened an emergency meeting with a local circuit judge to develop a plan to get dozens of people with addictions into drug treatment and to close down what is being described as an “opioid den.”

“We have to take a public health approach,” said Judge Steve Leifman, who discussed the issue on Friday with officials from the Florida Department of Health, Jackson Memorial Hospital and the city of Miami. ”Any action taken has to be coordinated, lawful and appropriate to get those individuals into treatment as quickly as we can and to prevent new individuals with serious opioid addiction from returning to that area.”

The logistics of providing a large group of homeless people with drug treatment are challenging. Without giving specifics, Leifman said officials are close to finalizing a plan where several agencies will marshal dollars and people to take action soon.

“We need to make access to care easier, and that is not always the case,” he said.

The sentiment is shared by several of the homeless who live on these streets, who are confused by the heightened police presence and health officials carrying clipboards who have conducted interviews in recent days. They told the Miami Herald they fear being rounded up and arrested.

“I think they should arrest these f---ing dealers,” said Margot Kenyon, 46. “But they’ll go after junkies sitting on the street shooting up.”

Local health workers recently asked the police department not to do that, a plea that so far the cops have heeded.

“To conduct our investigation, it is imperative that the department know the location of those individuals who currently are found in that area,” wrote Lillian Rivera, director of the Miami-Dade health department, in a Sept. 19 letter to the Miami Police Department. “Disbursement or relocation of the population will significantly impact our ability to find those individuals and complete our investigation.”

Sylverin described living on a section of Northwest Second Avenue under the overpass, a shield from the elements. He spoke of run-ins with the police, losing friends to overdoses and trying to be discreet while being intimate with a woman even after the police tore down a small cardboard shelter he’d put together for privacy.

He and others said many people on the street have untold traumas in their lives that lead them to self-medicate. Over Sylverin’s shoulder on the opposite sidewalk, a man sat doubled over on a crate with his head resting on his forearms. Another man sitting on a mattress next to him slowly swayed back and forth as if in a daze, his eyes closed.

“A lot of people out here are sick,” Sylverin said.

On Wednesday, Rivera said the agency, which does regular monitoring for infectious disease, has begun investigating a potential health threat. She said health workers returned to the 836 overpass this week to draw blood from people living on the street. Health department workers have been working to get homeless residents into treatment and working alongside the needle exchange program run by the University of Miami to hand out clean syringes to those living under the overpass, she said.

“We have good disease intervention specialists who can take care of critical patients and who understand the HIV disease,” Rivera said. “We have to do an epidemiological analysis and all that stuff that comes afterward. We’re in the investigative stage, and we don’t know what will come out of it.”

Homeless people who interact with the UM program say the workers are the most helpful people they encounter on the street. Several credited the exchange with slowing the spread of disease and bringing a new attitude to helping people with drug addictions. Besides allowing injection drug users to trade in used needles for clean ones, the program refers people to drug treatment programs.

“I have the utmost respect and appreciation for the needle exchange,” said Michael, 24, who asked to be identified only by his first name.

The Infectious Disease Elimination Act Exchange was first sanctioned by Tallahassee in 2016, though with no public funding. The program is responsible for paying for itself through grants and private donations. A needle exchange isn’t meant to solve Miami’s problem with hepatitis C and and HIV, but to reduce the community’s overall risk. A 2015 study done in Washington, D.C., showed the number of HIV infections dropped significantly after the creation of a needle exchange program in 2008.

The people on these streets say they mostly clean up after themselves and try to keep any young passersby from seeing any drug use or sex by yelling “kids” when children walk by. Not everyone heeds the call.

Many talk about the difference between now and 2016, when the potent synthetic opioid fentanyl hit the street and caused a rash of overdose deaths.

“Ambulances would come eight, nine, 10 times a day,” said Nicole Perez, 24.

Still, the current concentration of drug use and the condition of the streets under the 836 have stirred strong reactions in City Hall. Miami City Commission Chairman Keon Hardemon expressed his frustration at the sight of needles and trash — aluminum cans, plastic bottles, food containers — littering the fenced-off soil between the streets.

“Give me a break. Somebody give me a f---ing break,” Hardemon said at a public meeting last week. “This has to stop.”

School officials reacted too. On Wednesday, Superintendent Alberto Carvalho warned parents about needles and other debris found outside nearby schools. “I encourage all students and families to remain vigilant and immediately report any suspicious activity or loitering individuals” to school administrators, he said in an email.

The police department, accused of harassment and street sweeps that violate the agreement, is now tasked with balancing the wishes of public health officials and politicians. For now, the cameras have been mounted to see if drug deals are occurring in the open, and vehicular traffic has been restricted.

“I don’t know how long we’ll keep that up for,” said Police Chief Jorge Colina, adding that he has to respect people’s rights to be in that space and walk through it. “We can’t restrict pedestrian access.”

Herald staff writer Colleen Wright contributed to this report.

Miami officials have closed four streets under the 836 expressway in Overtown as health officials investigate the spread of HIV and hepatitis C.
Joey Flechasjflechas@miamiherald.com